|
|
|
POST-MENOPAUSAL HORMONE REPLACEMENT AND OVARIAN CANCER: (July 2003) The results of studies on risk of ovarian cancer following treatment with estrogens or an estrogen-progestin hormone combination are remarkably inconsistent - some show increased risk, most no effect, and some even suggest estrogens protect against ovarian cancer. A new study from the National Cancer Institute published in the July 17, 2002 issue of the Journal of the American Medical Association provides some additional interesting information. They followed 44,241 postmenopausal women who were given either estrogens alone or estrogens plus progestins. During the followup period, 329 ovarian cancers occurred. Those who used estrogens alone for four to nine years had a 60 percent increased risk. That risk increased further with longer use; 80 percent greater risk for ten to nineteen years of use, and a threefold increase in risk for those using over twenty years. In contrast, there was no increased risk for those who used estrogens and progestins. The authors concluded: "women who used estrogen only replacement therapy, particularly for ten or more years, were at significantly increased risk of ovarian cancer". Commentary: This is a perfectly good study, but it does not settle the issue. - In each of the groups showing increased risk with longer duration use, the number of cases was relatively small (16 to 25 cases). - Many of the women who had long-term treatment likely received for some period of time considerably larger doses of estrogen than is used now. That might have increased their risk and might make the study less relevant to the lower doses used currently. - The combination of estrogens and progestins did not increase the risk of ovarian cancer, but that is a regimen that has been generally used only relatively recently. To be sure about the safety, those using the combination would have to be followed longer (here, the followup period was usually for less than five years, and the number of women who used the combination and developed ovarian cancer was small).
The various studies are so inconsistent that a potential greater risk of ovarian cancer with estrogen treatment postmenopausally should not, at present, be a significant factor in decisions about hormone use. Additionally, of course, most women would be given estrogens plus progestins which, in this study, was not associated with greater risk. The bigger issue with hormone replacement therapy postmenopausally, particularly the estrogen-progestin combination, is the risk of heart attack, stroke, and breast cancer (see editorial of August 2002 in the Archives titled "Estrogen use takes a big hit"). Lacey, J.V., Jr, et al. Menopausal hormone therapy and risk of ovarian cancer. Journal of the American Medical Association. Vol 288 (July 17) Pgs 334-341. 2002.
|
||||||||||||||||||||||||||
|
UMDNJ Home Healthful Life Home Top |
|||||||||||||||||||||||||||
